Approval of the Affordable Care Act Falls Back Below 50%

Story Highlights

48% now approve of Affordable Care Act; 47% disapprove

64% want the ACA kept in place, including 46% who want changes

31% would like to see the ACA repealed and replaced

WASHINGTON, D.C. -- Americans' approval of the Affordable Care Act (ACA) continues to edge downward from its record-high 55% in April 2017, when congressional Republicans first attempted to dismantle it. The public is now about evenly divided in their opinions of the 2010 healthcare law, with 48% approving and 47% disapproving.

Americans' opinions of the ACA have fluctuated over the past six years, but before April 2017, as congressional Republicans were attempting to dismantle it, an average 43% of Americans approved of it and 51% disapproved. The April and July 2017 readings were the only times Gallup has measured approval at the majority level, and by November 2017, approval had slipped to 50%.

Gallup has regularly tracked Americans' overall approval of the ACA since November 2012 and has gauged what they would like to see happen to it since November 2016. In this year's annual Health and Healthcare update, conducted Nov. 1-11, Gallup once again asked Americans who approve of the ACA whether they would like it kept in place as is, or kept but with significant changes. Similarly, Americans who disapprove of the ACA were asked if they wanted to keep it but with significant changes, or repeal and replace it.

Combining the responses to these two questions, a total of 46% of Americans -- including some who approve of the ACA (30%) and some who disapprove (16%) -- want to change it significantly without repealing it. Thirty-one percent disapprove and wish to see it repealed and replaced, and 17% approve of the ACA and want it kept as is. The current readings are roughly in line with last November's findings, but tilted slightly more toward keeping the law in some form than was true in 2016, when 37% supported repealing and replacing it.

After congressional Republicans failed several times in 2017 to repeal and replace the ACA, they abandoned their efforts and shifted their focus to federal tax cuts. But those unsuccessful efforts had little effect on the views of rank-and-file Republicans. Currently, 65% of Republicans disapprove of the law and want it repealed -- down only slightly from the 71% who said the same shortly after Donald Trump was elected in 2016. Most of the remaining Republicans, 24%, disapprove and want the law changed significantly, but not repealed.

For their part, 82% of Democrats approve of the law and think it should be kept as is (34%) or kept but with significant changes (48%). Fewer political independents today disapprove of the law and endorse repealing it (25%) than did so in 2016 (37%). However, just 13% approve of the law and support keeping it in its current form, similar to what Gallup measured in 2016 (11%).

Overall Approval of the Affordable Care Act Remains Highly Polarized

Views of the ACA remain sharply polarized politically, with Democrats' approval consistently high and Republicans' consistently low. Independents' approval hit a recent peak of 56% in 2017 and has since dropped to 47%. Republicans' approval has also retreated after reaching 17% in early 2017. After surging 10 points in early 2017, Democrats' approval has largely held at the mid-80% level.

Bottom Line

Since the ACA's passage without a single Republican vote in favor, the law has been a contentious political issue in the U.S. Republicans' opposition to the ACA helped them win control of the House in 2010, control of the Senate in 2014, and the presidency in 2016. However, after suffering several bruising defeats in attempts to repeal and replace the ACA in 2017, congressional Republicans set their sights on other legislative priorities. Rank-and-file Republicans remain firmly supportive of efforts to dismantle the law, but this year's Democratic electoral gains in the U.S. House of Representatives virtually guarantee it will not be repealed in the next Congress.

Still, with less-than majority-level approval of the law and 46% of the public calling for significant changes to it, lawmakers clearly have some work to do in fixing the nation's healthcare system to their constituents' satisfaction.

Results for this Gallup poll are based on telephone interviews conducted Nov. 1-11, 2018, with a random sample of 1,037 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 70% cellphone respondents and 30% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

President Donald Trump has a 53% approval rating on his handling of the economy, about the same as in August. His ratings for handling foreign affairs, immigration and healthcare are significantly lower.